Alcohol-related liver disease is a significant problem throughout the world. Cirrhosis is a leading cause of death in American urban men between the ages of 25-64. In addition, women appear to be even more susceptible than men to alcohol-related morbidity and mortality. Hospitalization costs, disability, and loss of productivity related to alcoholic liver disease amount to billions of dollars of costs annually in the United States.
Alcoholic hepatitis is the term for a clinicopathologic syndrome resulting from excessive alcohol consumption characterized by an acute or subacute clinical presentation and a distinctive appearance on liver biopsy. Mild cases may resolve spontaneously after cessation of alcohol consumption. Hospitalized patients with severe alcoholic hepatitis, however, have a one month mortality between 29-52%. In addition to the short-term mortality, the probability of alcohol-related hepatitis progressing to cirrhosis is estimated at 10-20%/yr. Long-term survival rates are influenced by continued alcohol consumption and nutritional factors, but return to normal liver function and architecture after an episode of alcoholic hepatitis are possible.
The high mortality rate for hospitalized alcoholic hepatitis patients is observed despite aggressive treatment of fluid and electrolyte disturbances, malnutrition, withdrawal symptoms, encephalopathy, gastrointestinal bleeding, and infection. Numerous trials for alcohol-related liver disease have been undertaken including treatment with anabolic steroids, colchicine, propylthiouracil, nutritional support, and insulin/glucagon. None of these treatments has been unequivocally associated with decreased mortality during the acute illness or diminished progression of alcoholic hepatitis to cirrhosis.
Nor is the scenario for other inflammatory liver, pancreatic and intestinal disorders much more positive.
There is no recognized treatment for chronic viral hepatitis other than interferon administration and interferon administration has proven effective only in a minority of patients and may cause significant side effects. Chronic vital hepatitis may progress to cirrhosis and/or liver cancer.
There is no known treatment for decreasing the inflammation in chronic pancreatitis.
The fact that no single approach is used for chronic Crohn's disease indicates the inadequacy of the various treatments.
Chronic ulcerative colitis can require proctocolectomy.